The Healthcare Common Procedure Coding System (HCPCS) is a collection of standardized codes for medical procedures, supplies, products and services. HCPCS includes two levels of codes. Level I consists of Current Procedural Terminology (CPT) codes which are used to identify medical services and procedures ordered by physicians or other licensed professionals. Level II of the HCPCS codes identifies non-physician services (e.g. ambulance services, durable medical equipment, or pharmacy).
In 1966, the American Medical Association (AMA) published the first edition of CPT codes.1
In 1983, CPT was adopted as part of the Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS).1
The Health Insurance Portability and Accountability Act (HIPAA) of 1996, made CPT and HCPCS as the national standards for electronic transaction of healthcare information.1
HCPCS and CPT codes are vital for standardized medical procedure reporting and allows for healthcare utilization to be evaluated, medical guidelines to be developed and research to be generated.1
CPT codes are maintained by the American Medical Association and they were designed to describe medical, surgical, and diagnostic services accurately. CPT codes are also used as a form of uniform communication among physicians, coders, patients, payors, etc. and as an analytical tool for certain medical procedures and services. HCPCS, however, is a set of healthcare procedure codes based on CPT. It was designed to provide a standardized coding system for describing specific items and services. It is a necessary form of coding for Medicare, Medicaid, and other health insurance programs for claims processing.2 CPT operates in three categories: Category 1 covers procedures and Food and Drug Administration approved services; Category 2 contains supplementary tracking codes that are used for performance measures and are intended to help collect information on the quality of care; and Category 3 consists of temporary codes that cover emerging technologies, services and procedures.3 On the other hand, HCPCS operates on three separate levels, in addition to the aforementioned Level I and II, there are Level III codes, called local codes. Level III codes were developed by state Medicaid agencies, Medicare contractors, and private insurers for use in specific programs and jurisdictions.4
There are instances where a CPT and a HCPCS Level II code have identical narratives for a procedure or service; in this case the CPT code should be used. If the narratives are not identical, then the HCPCS Level II code should be used. When a CPT code description contains an instruction to include additional information, (e.g. describe a medication) a coder should check for a HCPCS national code. HCPCS Level II codes specify supplies in greater detail than CPT codes, specifically, J codes comprise most of the drugs and biologics that should be reported with infusions, injections, and supply codes.4
As of 2021, there are nearly 7,000 HCPCS codes and more than 10,000 CPT codes.5,6
In terms of public knowledge, the AMA holds the copyright to the CPT codes, and they have mandated that access to the codes is contingent upon payment of a license fee. In contrast, HCPCS are public record and can be accessed freely by those who use Medicare, Medicaid, or any other private insurer.2
Dotson P. CPT® Codes: What Are They, Why Are They Necessary, and How Are They Developed?. Adv Wound Care (New Rochelle). 2013;2(10):583-587. doi:10.1089/wound.2013.0483
Difference Between HCPCS and CPT. Difference Between Similar Terms and Objects. http://www.differencebetween.net/science/health/difference-between-hcpcs-and-cpt/. Published 2009.
Lee K. Current Procedural Terminology (CPT) code. TechTarget. https://searchhealthit.techtarget.com/definition/Current-Procedural-Terminology-CPT. Published 2015.
Webb L. Note similarities and differences between HCPCS, CPT® codes. JustCoding News: Outpatient. https://www.hcpro.com/HIM-284009-8160/Note-similarities-and-differences-between-HCPCS-CPT-codes.html. Published 2012.
2020/2021 HCPCS Codes. HCPCSData.com. https://www.hcpcsdata.com/Codes. Published 2020.
CPT® codes, then and now. CPT. 2015. https://www.ama-assn.org/practice-management/cpt/cpt-codes-then-and-now.